Neurologic injury occurs in approximately 30-70% of children who require cardiac surgery. While the brain is considered “the heart of the matter” by the congenital cardiac surgery team, critical details of care during cardiopulmonary bypass (CPB) vary between cardiac surgery centers. Neurologic injury from CPB requires a multifaceted solution, including improved real-time assessment of the adequacy of cerebral blood flow.
For example, autoregulation refers to the maintenance of constant cerebral blood flow across a range of cerebral perfusion pressures. Autoregulation is a homeostatic mechanism that protects the brain from excessive or inadequate blood flow. Monitoring autoregulation may be useful during cardiopulmonary bypass. Patients with impaired autoregulation are more likely to die or suffer permanent neurologic disability. Autoregulation monitoring can be used to delineate care practices that enhance the ability of the brain to regulate its own blood flow. However, conventional autoregulation monitoring often takes a considerable amount of time.